1. Remote Consult in Radiotherapy HEP Technologies in Health Physics! Dipartimento di Fisica e Sezione INFN Università degli Studi di Genova squarcia@ge.infn.it Maurizio Ferraris, Paolo Frixione, Sandro Squarcia CHEP 2000, Padova, 2000 February 7-11

2. Health care needs... Physical devices are quickly improving Computed Tomography, Nuclear Resonance, Computer Radiography, Echography…. Informatics is becoming more and more important Networking among clinical departments is now usual... and physics transfer - We are in hospitals (Health Physics) - We have technologies - We know how to fit them in medical world Teleconsultation for better patient care! New technologies have completely changed medical duties

3. Modern Radiology Department SD100 CR WS PC Juke Box CD Computer Radiography devices Archive devices Medical report and consultation devices Remote connection

4. Multiple integration Picture Archive Computer System (PACS) Clinical modalities (TC, MR, CR...) Hospital Information System (HIS) Radiological Information System (RIS) Medical report Booking Hospital Area Network

5. Teleconsultation Construction of a clinical folder with images Possibility of on-line interaction Possibility of follow-up check Possibility of statistical clinical data elaboration Foundation for the use development of hadrons (instead of electrons/gammas) in radiotherapy cancer cure Has supported NORMA Network Oriented Remote Medical Archive

6. NORMA A ad hoc clinical folder for images transmission Network Oriented Remote Medical Archive

7. Hardware security Two area completely separated Two Ethernet card in the firewall A true gate from outside world Secure clinical data accessibility Hospital global network Radiotherapy (or radiology) divisional network

8. Software security Patient data identification Patient clinical folder owner Access mode Level 1: Pathology Statistical analysis (free for network partners) Level2: Teleconsultation Anamnesis and diagnosis (on owner authorization) Level 3: Treatment Patient general data (on patient authorization) Owner mail address

9. NORMA characteristics Menu frame Blue for data insertion Green for data consultation General system information Body Frame Patient information

10. Active image selection Clinical images (JPEG format) not for teleconsulting! Different data handling possibility

11. Clinical information retrieved Patient personal data Study information Series description of clinical image series Image data describing clinical images (mode and pixel definitions) DICOM Information Model Digital Information and COmmunication in Medicine

12. Remote consulting tool DICOM module WWW-DICOM gateway JAVA SERVER Remote consulting client Remote consulting client Hospital A Hospital B NORMA helps physicists and medical doctors to select the best treatment planning in radiotherapy discussing on images retrieved from DICOM PACS through a client/server application developed in Java. DICOM IMAGES

13. Digital Images Retrieve To LAN Network PACS System WWW- DICOM Gateway Eurostore Connection Modalities Workstations NORMA Eurostore archive Image Transfer Connection

14. EUROSTORE Project European Project to design and develop an high performance distributed storage system Consortium formed by scientific and industrial partners  QSW (Supercomputer - UK)  CERN (Science - Swiss)  DESY (Science - Germany)  HCSA (Space Technology - Greece)  TERA Foundation (Science - Italy)  HNMS (Met-Service - Greece)  AMC (Medical - Greece) Features: Scalability Reliability and security Easy hardware and software support Eurostore (Java 100%) will run on, almost, all hardware and software systems available today

15. WWW-DICOM gateway Client/server architecture: Presentation logic: Web Browser Application server: Web Server Business logic: DICOM gateway Data management: DICOM Server WWW Browser WWW Server DICOM Server CGI interface DICOM gateway HTTP JPEG conversion DICOM gateway opens and submits a DICOM association to DICOM Server, receives a response and makes JPEG conversion

16. Sun SPARCserver 1000 Sun DISKserver 1000 (HTML + JavaScript) Intranet Web Server Web Browser CGI Library Requests Parser DICOM Upper Layer Data encoding Data decoding Image processing JPEG translation Response builder (Data)(Images) (Data) + (Commands) (Name-value pairs)(HTML file) (HTTP) (URL-encoding) DICOM MODULE WWW MODULE Sun DISKserver 1000 DICOM Application Entity LAN(DICOM protocol) Data Exchange Mode WWW Domain DICOM Domain WWW-DICOM Gateway

17. Teleconsulting Features and Functionalities Feature: Secure user authentication secure socket layer protocol activities registration on log file Platform independent Java applet running on every Web Browser Functionality: Access to medical image archives (PACS) Selection (and transmission) of clinical images zone Discussion of clinical cases among remote users

18. Client/Server Teleconsulting Architecture Client: Java Applet for running on every Web Browser Communication management Graphical user interface - mouse drawing on clinical images - information exchange using the chat area Server: Java application installed on NORMA system Client communication management Log files activities registration Multithread software architecture Protocol: Communication performed using a built-in proprietary network protocol

19. JAVA SERVER WEB SERVER HTTP Connection Proprietary protocol CLIENT A CLIENT B JAVA Applet JAVA Teleconsulting

20. Proprietary Protocol Client 1Java Server Client 2 Waiting for connection Connection Request Send priority code Receive code Time Waiting for client 2 connection Connection Request Send priority code Receive code Send ID client 2 Receive and send ID2 Receive ID2 Verify connection status (polling) DATA EXCHANGE CONNECTIONCONNECTION

21. Connection to the PACS System User Autenthication DICOM association

22. DICOM Connection Monitoring DICOM Console Visualization of data exchanged during DICOM communication

23. DICOM Patient Data Consulting Patient list Patient personal data

24. DICOM Study Information Study list Study information

25. DICOM Series Information Series list Series information

26. DICOM Images Dump of DICOM dataset Retrieve of clinical images

27. Images Remote Consult Discussion area Help area Toolbar

28. Conclusions The developed system is a research product helping physicists/medical doctors to select the best radiotherapy treatment planning Users working in different places can discuss interesting clinical cases visualizing in a Web Browser supporting Java the same diagnostic images at the same time highlighting zones of interest